Background Shock in dengue hemorrhagic fever (DHF) still con-stitutes an important problem in children. Predicting DHF patientswho will develop shock is difficult.Objective The aim of this study was to find out factors associatedwith shock in DHF.Methods This was a prospective observational study. Subjectswere children hospitalized from April to July 2000 who met theWHO criteria for DHF and had positive serological confirmation.Association between independent variables (age, gender, dura-tion of fever, abdominal pain, vomiting, hepatomegaly, plateletcount, hematocrit level, and nutritional status) and the dependentvariable (shock) was analyzed by logistic regression model..Results There were 85 children who met the eligibility criteriaconsisting of 50 (59%) boys and 35 (41%) girls with an averageage of 7.1 years (SD 2.88). Shock occurred in 42 (49%) children.Of the 42 children with shock, the age group of 5-9 years madeup the biggest group (57%) consisting of 23 (55%) boys and 19(45%) girls. Hepatomegaly was found in 32 (76%) children, ab-dominal pain and vomiting in 30 (71%) and 36 (86%) children,respectively, and good nutrition in 22 (52%) children. Shock oc-curred mainly on the fourth and fifth days (76%). Almost half ofthe patients (45% and 52%) had hematocrit level of 46-50% andplatelet count of 20,000-50,000/ml, respectively. By logistic re-gression analysis, it was found that duration of fever, abdominalpain, hematocrit level, and platelet count constituted indepen-dent factors correlating with shock in DHF.Conclusion Abdominal pain, fever lasting four to five days, hema-tocrit level of >46%, and platelet count of <50,000/μl were associ-ated with shock in DHF
Latar belakang.Insiden dan angka kematian tetanus anak masih cukup tinggi di Indonesia. Di Bagian Ilmu Kesehatan Anak RSCM Jakarta, dari tahun 1990 sampai 1993 dirawat rata-rata 20,3 kasus tetanus anak per tahun dengan case fatality rate(CFR) berkisar antara 12,9 sampai 27,4%. Laporan penelitian di Manado belum ada, maka diperlukan mengetahui profil penyakit tetanus anak yang dirawat di RS Prof. Dr. R.D. Kandou, Manado.Tujuan. Mengetahui profil tetanus pada anak yang dirawat di RSUP Prof. Dr. R.D. Kandou ManadoMetode. Reviewretrospektif anak yang didiagnosis tetanus di RS Prof. Dr. R.D. Kandou Manado dari Januari 2002-Januari 2012. Data dianalisis secara deskriptif.Hasil. Empat puluh anak tetanus berusia 1-11 tahun, 65% kasus laki-laki, dengan fokus infeksi terbanyak otitis media 21 (52,5%). Sebagian besar (45%) belum pernah mendapat imunisasi dasar terhadap tetanus. Masa inkubasi berkisar dari 5 hari sampai 1 bulan, dengan period of onsetterpendek 10 jam. Komplikasi terbanyak bronkopneumonia (19 pasien) dan 6 pasien meninggal.Period of onsettetanus anak yang meninggal lebih singkat secara bermakna dibandingkan yang hidup (1,12 vs 3,32 hari (p=0,004)), demikian pula antara tetanus berat dan ringan sedang (1,85 vs 3,85 (p=0,02)). Lama perawatan rata-rata yang diberi antitoksin tetagam(human antitetanus serum)tidak berbeda bermakna dibandingkan yang diberi ATS yaitu 11,5 vs 14,3 hari (p=0,440). Kesimpulan. Pasien tetanus yang dirawat inap di RS Prof. Dr. R.D Kandou sejak 2002-2012 terbanyak adalah tetanus sedang. Sebagian besar pasien belum pernah diimunisasi terhadap tetanus. Period of onsetpasien tetanus yang meninggal ataupun tetanus berat lebih singkat dibandingkan yang hidup ataupun tetanus ringan sedang. Lama rawat pasien yang diberi antitoksin tetagam dan ATS tidak berbeda
Background World Health Organization (WHO) has recommended that countries with drug resistant malaria problem use combination therapies, especially artemisinin-based combination therapy (ACT). However, there is limited information on the efficacy of ACT in North Sulawesi. Objective To compare the efficacy of artemether-lumefantrine and artesunate plus sulfadoxine-pyrimethamine (SP).
Background Dengue shock syndrome (DSS) is characterized bysevere vascular leakage and hemostasis disorder. It is the cause of death in 1 to 5 percent of cases. WH 0 management guidelines for resuscitation remain empirical rather than evidence-based.Objective To find out the alternative fluids to replace plasmaleakage in DSS.Methods We performed a prospective study and randomizedcomparison of plasma and gelatin solution for resuscitation ofIndonesian children with DSS. We randomly assigned 25 subjectswith DSS to receive plasma and 25 children to receive gelatinfluid. Statistical analyse were performed using chi-square test,Fisher's exact test, t test, Mann-Whitney test.Results The increment of pulse pressure width and the decrement of hematocrit in subjects treated with gelatin were higher than that of plasma atfour-hour therapy (P=0.002 and P=0.017). Only one patient died caused by unusually manifestation of DSS. The increment of body temperature in subjects treated with plasma was higher than that of gelatin at four-hour therapy (P=O.Oll). The decrement of platelet count in subjects treated with gelatin were less than that of plasma (P=0.018). The increment of diuresis rate in subjects treated with gelatin was higher than that of plasma at twenty-hour therapy (P<O.OOOl). The decrement of respiratory rate in subjects treated with gelatin was higher than that of plasmaat twenty-eight hour therapy (P=0.018). There was no differencein studied variables : total volume rate, blood pressure, pulse rate, re-shock rate, clinical fluid overload, allergy reactions, bleeding manifestations, and length of stay (P>0.05).Conclusions Gelatin solution can be used as volume replacementin resuscitation of DSS if blood plasma is not available especiallyat four-hour therapy.
Background Febrile neutropenia (FNP) is a common complicationof therapy among children with cancer. It is one of the causes ofsignificant morbidity and mortality in children and young adultstreated for cancer. With aggressive management of FNP, theoutcome of episodes in children has improved dramatically.Objective To determine factors associated with FNP, to assess how varied the current management, and to evaluate the outcome of FNP in childhood leukemia in Manado over the last 10 years.Methods Data from medical records was collected retrospectivelyfrom January 1997 to December 2006. Variables studied were: age, sex, nutritional status, sosio-economic status, type of leukemia, degree of fever, ANC at fever, phase of chemotherapy, antibiotic used, episodes ofFNP and the outcome of patients.Results Twenty of ninety one patients were studied. The mortality rate was crucial i.e., 11 of20, it was higher in boys than that in girls. Most children have severe to very severe neutropenia and more than half died (7 /13). Seven out of 12 malnourished patients died. Sixteen children are suffered from acute lymphoblastic leukemia (ALL). The outcome of high risk (HR) patients was worse than that of standard risk (SR). FNP occurred along the phase of chemotherapy. None of the factors studied showed significant difference. The choice of antibiotics is varied.Conclusion The outcome of FNP in our institution is grave.There is a need to evaluate application and compliance to thestandard guidelines.
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